What They Want in a Health Care Plan

By Jennifer Tolbert and Larisa Antonisse
Kaiser Family Foundation, February 22, 2017

In order to gain a better understanding of the personal experiences of Trump voters with health coverage provided through the ACA and the changes they would like to see in the health system moving forward, the Kaiser Family Foundation (KFF) held focus groups with individuals who voted for Trump in cities in three battleground states: Grand Rapids, Michigan; Columbus, Ohio; and Harrisburg, Pennsylvania.


* Three years into the implementation of the Marketplaces, participants still seemed overwhelmed by their plan choices and confused about key aspects of their plans.

* Participants were particularly frustrated by unaffordable out-of-pocket costs associated with high deductibles.

* The high cost of prescription medications was a common complaint and many Marketplace participants did not believe their plan protected them from these costs.

* Participants also expressed frustration at receiving surprise medical bills for services they thought were covered.


* When asked what they would want in an ACA replacement plan, participants’ top priority was coverage that was more affordable—affordable premiums, but most importantly, affordable out-of-pocket costs.

* They also wanted more help for people like them.

* Access to doctors and hospitals was another priority for participants.

* Participants wanted simplification of health plan choices and greater transparency from the insurance companies.


* Participants rejected the idea of high deductible plans, even when coupled with premium tax credits to cover the premium and Health Savings Accounts (HSAs) to save for out-of-pocket costs.

* While there was general support for the concept of an HSA, many did not understand what they were and said they did not have the savings, or would not be able to save enough during the year, to cover the out-of-pocket costs associated with a plan with a high deductible.

* Participants also rejected the concept of basing tax credits solely on age regardless of income.

* Frustrated by the complexity and uncertainty of the current system as well as proposals to replace it, several participants advocated for a single-payer system modeled on the Canadian health care system.


These focus groups were uniquely composed of Trump supporters in battleground states who also received health care coverage through the Affordable Care Act. Were they, like many conservatives, supporting the repeal of ACA – a leading issue for Donald Trump in his campaign? If they were not satisfied with ACA, then what did they want?

They remain concerned about three of the leading problems with today’s private health plans – high premiums, high deductibles, and narrow provider networks. Their top priority was affordability – affordable premiums and affordable out-of-pocket expenses. They also want greater access to physicians and hospitals than the narrow networks allow, and they do not want to receive surprise medical bills from out-of-network providers. They also want simplification of health plans (the greatest simplification being single payer).

Although some look upon Trump supporters as being conservatives who want to reduce the role of government, actually several in this group were able to pull together the policy issues and come to the conclusion that, to reduce “the complexity and uncertainty of the current system,” we should enact “a single-payer system modeled on the Canadian health care system.”

President Trump, these are your supporters. You need to read the article from the Annals of Internal Medicine: “Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs” by Steffie Woolhandler, MD, MPH and David U. Himmelstein, MD You can download it at this link: